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Frailty and ST-Elevation Myocardial Infarction - improved outcomes after an invasive strategy
Session:
Painel 7 - Doença Coronária 11
Speaker:
Diogo Santos Ferreira
Congress:
CPC 2020
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.4 Acute Coronary Syndromes – Treatment
Session Type:
Posters
FP Number:
---
Authors:
Diogo Santos Ferreira; Helder Santos; Guilherme Pessoa-Amorim; André Azul Freitas; Adriana Belo; Cristina Gavina; Rui Baptista; Sílvia Monteiro; Em nome dos investigadores do Registo Nacional de Síndromes Coronários Agudos
Abstract
<p><strong>Background: </strong>Frailty is common in patients presenting with ST-segment elevation myocardial infarction (STEMI). Current guidelines recommend an invasive approach regardless of functional status. However, it is uncertain whether the potential benefits of this strategy outweigh associated risks in this population.</p> <p><strong>Methods:</strong> We conducted a retrospective multicenter nationwide analysis of 5422 STEMI episodes between 2010-2019. A deficit-accumulation model was used to create a frailty index (FI), comprising 22 features (not including age). Frailty was initially defined as FI>0.25.</p> <p><strong>Results:</strong> A total of 511 (9.4%) STEMI patients were considered frail. Frailty was associated with increased Killip-Kimball class and GRACE score. Coronariography, percutaneous coronary intervention (PCI) and coronary artery bypass graft were less frequently performed in frail patients, who were offered radial access less often, and had multivessel disease more frequently. In-hospital use of P2Y12 inhibitors, beta-blockers, and ACEIs/ARBs was also less common. Frail patients had longer in-hospital stay and increased in-hospital all-cause and cardiovascular (CV) mortality. At discharge, aspirin, P2Y12 inhibitors and beta-blockers were less frequently prescribed. After 1-year, frail patients had increased all-cause and CV hospitalization and all-cause mortality. Using receiver-operator-characteristics curve analysis, a FI cutoff of 0.11 yielded the best accuracy to predict all-cause 1-year mortality (area under the curve: 0.629, p<0.001) – this cutoff was subsequently used to define frailty. Coronariography and PCI were associated with improved in-hospital and 1-year outcomes, regardless of frailty status or GRACE score (p<0.001 for all comparisons). Although frailty status modified the risk reduction from coronariography in in-hospital outcomes (Wald test p<0.05), the prognostic benefit of coronariography in 1-year outcomes, and PCI in both in-hospital and 1-year outcomes, remained unchanged (Wald test p>0.05 for all comparisons).</p> <p><strong>Conclusions</strong>: Frail STEMI patients are less frequently offered guideline-recommended therapy and invasive procedures. Coronariography and PCI are associated with short- and long-term prognostic benefits irrespective of frailty status or GRACE score. Increased adherence to current recommendations might improve clinical outcomes in frail STEMI patients.</p> <p> </p>
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